Month: December 2016

In February 2015, the Dane County Board of Supervisors got “sticker shock” at the price of a new jail. Members were also faced with opposition to the idea of spending money on a new jail, particularly since African-Americans make up a considerably larger share of the inmate population than their numbers in the general population.

“When we build them, we tend to fill them,” said Linda Ketchum, executive director of the Madison Area Urban Ministry, in an article by Joe Tarr in Isthmus.

Sheriff David Mahoney also pointed out the long-standing problem of housing people with mental illness in the jail. He told reporter Tarr, “We’ve always housed those individuals in disciplinary housing units–units that are meant to change behavior, not treat mental illness.”

Funding for programs that would provide mental health treatment instead of jail time has not kept up with population growth and need, according to David Delap, head of a diversion program run by the Journey Mental Health Center.

Mahoney concurs. “I haven’t heard of anyone stepping up to [provide services]. Since the ’70s, it’s been just the opposite.”

As a response to these problems, the Board appointed three task groups to come up with recommendations concerning problems with the criminal justice system in Dane County, with special attention to racial inequities and mental health. The groups moved quickly and the Board issued a final report in September 2015. Click here for the report.

Each group was to come up with 10 recommendations, five of which would require no new cost. Here are the recommendations concerning “mental health, solitary confinement, and incarceration.”

Remodel the current jail to reflect a more humane and modern facility.

Develop more culturally relevant and family centered outreach and engagement.

Add culturally relevant staff to work in collaboration with current mental health, substance abuse, or developmental disability services and community resources.

Create and sustain a culturally diverse workforce.

Reduce the length of time in solitary confinement and administrative segregation.

Convene a leadership team of mental health providers, advocates and others to explore financing issues. (County Executive should lead.)

Support the development of a plan to deliver additional training and resources for judicial officials, attorneys, and others involved in the court process, and

Convene a workgroup under the auspices of the Criminal Justice Council to identify and sustain to improve processes and expedite cases for inmates with significant mental health, substance abuse, and developmental issues as may be appropriate.

In April, the League of Women Voters of Dane County will host a forum to consider progress on these recommendations and other issues concerning mental health services in Dane County. Please feel free to comment on progress as you have seen it.

Reporters for Spotlight, the Boston Globe‘s famed investigatory unit, spent several months examining the mental health system in Massachusetts. They found many familiar problems in their state and a success story in an unlikely place: San Antonio, Texas.

Click here for their story “San Antonio became a national leader in mental health care by working together as a community.”

It took decades of hard work by leaders in the mental health and criminal justice systems to produce what is termed “the San Antonio model.” Here is a description from the article of the result.

“This coalition in San Antonio has built a crisis center for psychiatric and substance abuse emergencies and a 22-acre campus for the homeless that resembles a community college. To date, more than 100,000 people have been diverted from jail and emergency rooms to treatment, local officials say, resulting in a savings of nearly $100 million over an eight-year period. Thousands of emergency responders in San Antonio and Bexar County have been trained to manage mental health crises.”

MOSES, the interfaith organization, presented the model to the task group on mental health and criminal justice appointed by the Dane County Board of Supervisors. There are obvious differences between Bexar and Dane Counties, but the article provides many good ideas about how we can move forward to address long-standing problems.

The massive and controversial 21st Century Cures Act includes provisions designed to reduce the number of people with mental illness in jails and prisons.

According to the Justice Center of the Council of State Governments, “The bill encompasses the Mental Health and Safe Communities Act, which authorizes funding for services related to mental health in the criminal justice system, including for identification, treatment centers, crisis response and intervention, reentry and transition assistance, and mental health courts. It also includes the Comprehensive Justice and Mental Health Act … [which] would facilitate collaboration among the criminal justice, juvenile justice, and behavioral health systems to ensure that people with mental illnesses receive the support they need.” The Senate is expected to pass the bill during the first week of December. Click here for full article.

Many of these provisions support the recommendations of three task groups appointed by the Dane County Board of Supervisors last summer. Click here for their report, “Investigating Solutions to Racial Disparities and Mental Health Challenges in the Dane County Jail and throughout Dane County’s Criminal Justice System.”

The legislation, however, is a mixed blessing. NPR reported that PhRMA, the trade group for pharmaceutical companies, spent $24.7 million lobbying for provisions in the bill. Senator Elizabeth Warren claims they were successful, charging that the bill was “hijacked” by the pharmaceutical companies. The legislation would ease requirements for approval of drugs and medical devices and eliminate some reporting requirements for doctors who accept money from drug manufacturers.

Click here for Warren’s statement and here for an NPR report on winners and losers if the legislation becomes law. Consumer and patient safety groups are listed as losers, as is preventive medicine. Advocates for mental health are listed as winners.

UPDATE: Click here for updated information about the impact of CURES on criminal justice/mental health reform.

Every headline brings a new worry. Buried among the frightening announcements is the statement that the new administration will push for Medicaid block grants.

The change seems benign. For 25+ years Republicans have been making the argument that block grants would allow states more flexibility in administering funds and save money. The typical proposal would provide each state with a lump sum to meet needs served by the program. The annual federal increase would be linked to general inflation instead of to increase in need or inflation in health care costs. In return, states would be freed of many regulations concerning how and to whom they provide health care coverage. Speaker Paul Ryan (R) has proposed block grants and has administration backing for his next attempt.

The reality would be an escalating reduction in access to health care for low-income people. A report by the Center on Budget and Policy Priorities contains this language. “As the Congressional Budget Office concluded in 2012 [about Ryan’s proposal] the magnitude of the reduction in spending…means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both. Cutbacks might involve reduced eligibility…coverage of fewer services, lower payments to providers, or increased cost-sharing by beneficiaries…all of which would reduce access to care.

The Urban Institute estimated that the 2012 Ryan proposal would lead states to drop between 14.3 million and 20.5 million people from Medicaid by the tenth year…and would lead states to cut reimbursements to health care providers by more than 30 percent…” Click here for the report.

Why should this change worry advocates? Quite simply, Medicaid pays the bills for many mental health services. In fact, it is more important as a source of funds for those services than private insurance and is particularly critical for people with serious mental illness.

Medicaid pays for inpatient care in general hospitals, medication, and doctor’s fees. Many states also use Medicaid funds to provide optional services such as supportive home care, case management, transportation, peer counseling, and respite care. Patients, family members, advocates and medical professionals have spent years battling for those improvements. Those gains could be eroded and even dismantled under a block grant program. In addition, reimbursements to doctors–which already are low–likely would be cut even further.

UPDATE: Click here for an article by David Wahlberg in the WSJ about the impact of Trump’s health care proposals in Wisconsin.